印度:超級細菌培養皿

'Some antibiotic resistance was first detected in India. One of the reasons for this is that many antibiotics are used in India, and often these have been bought by patients and not used under prescription. This means that antibiotics are used very widely, not always to treat bacterial infections and not always at the correct dose.'

某些抗生素抗藥性在印度是首次發現，原因之一是印度濫用抗生素的現象十分普遍，許多病人未經醫囑隨意購買抗生素。這意味着抗生素既沒有按照正確的計量使用，也並不總用來治療細菌感染。

'This provides a 'breeding ground' for the development of antibiotic resistant bacteria.'

這爲抗生素抗藥菌提供了發展的‘土壤'。

Laura Piddock, who leads Britain's Antibiotic Action, tells Vaihayasi Pande Daniel/ how India can defend itself on a war footing against the scourge of superbugs, or bacteria that have become resistant to antiobiotics.

勞拉﹒皮多克是英國抗生素運動的領導人，她告訴瓦哈亞西﹒潘迪﹒丹尼爾/印度應如何準備與(對大多數抗菌素產生抗藥性的)超級細菌做鬥爭.

A sick child in a hospital in Patna. Hygiene is very crucial to the prevention of the spread of superbugs, says Professor Laura J V Piddock, who heads Antibiotic Action. Photograph: Adnan Abidi/Reuters.

上圖爲巴特那一家醫院中的一位病孩。抗生素運動的發起人勞拉﹒JV﹒皮多克教授表示，衛生對於預防超級細菌的傳播至關重要。

What exactly are superbugs?

超級細菌到底是什麼？

Do all of us need to be worried about these multidrug-resistant bacteria?

我們應該擔心這些抗生素抗藥菌嗎？

Is India also bleakly facing the approach of a time when antibiotics will be toothless?

印度是否正消極面對抗生素失效的那一天？

How can we protect ourselves from superbugs?

我們應該如何抵禦超級細菌？

Laura J V Piddock, professor of microbiology at the University of Birmingham, the United Kingdom, also heads up Antibiotic Action, an independent UK-led global initiative working to push home the gravity of this problem facing people the world over.

勞拉﹒JV﹒皮多克是伯明翰大學的微生物學教授，也是抗生素運動的發起人。抗生素運動是一項英國主導的獨立運動，致力於向全球傳播抗生素抗藥菌問題的嚴重性。

"It is vital to the health of all nations that antibiotics remain the mainstay of modern medicine and are available to all on an equitable basis," she tells Vaihayasi Pande Daniel/ in an e-mail interview.

皮多克教授在一封電子郵件中，向網站的哈亞西﹒潘迪﹒丹尼爾：“抗生素仍是現代醫學中最重要的發現之一，向所有人一視同仁的提供抗生素對於人類健康至關重要。”

About Antibiotic Action, Piddock says, contributes to "national and international activities and acts as a conduit through which all stakeholders -- from the general public to healthcare professionals to politicians -- are educated on the importance of new ways to treat bacterial infections".

皮多克教授表示，抗生素運動爲“普羅大衆、醫療從業者和政治家 – 所有利益攸關者瞭解治療細菌感染的新途徑”做出貢獻。

How did the phenomenon of superbugs becoming drug-resistant come about? What were the factors that led to the misuse and overuse of antibiotics?

超級細菌是如何變得具有耐藥性的？是什麼因素導致亂用和濫用抗生素？

Bacteria evolve to survive in hostile environments.

細菌通過進化適應惡劣的環境。

Antibiotics can be viewed as making a hostile environment and so put evolutionary pressure on bacteria so this drives the evolution of strains resistant to antibiotics. Whilst many bacterial strains remain susceptible within a population, mutations occur very rarely to give resistance.

我們可以把抗生素看作爲細菌創建了一個不利的環境，從而促使細菌菌株進化出抗藥性。然而在一定數量內，許多細菌菌株對抗生素仍十分敏感，發展出抗性的突變是非常罕見的。

However, because antibiotics kill all of the susceptible bacteria in that population, the resistant bacteria remain and are able to grow up.

因爲抗生素殺死了那些對抗生素敏感的細菌，而具有抗性的細菌活了下來，繼續成長。

Bacteria grow very quickly and their generation time, such as for , is 20 to 30 minutes. This means that many rare mutant bacteria that are antibiotic resistant can grow up and become millions and millions of cells within 24 hours.

細菌生長的速度非常快，更新換代的速度，如大腸桿菌，是20至30分鐘。這意味着許多發展出抗藥性的罕見變異細菌能在24小時內繁殖出數以百萬計的細胞。

Even for the bacteria that cause tuberculosis, which grow extremely slowly, resistant bacteria can emerge and proliferate within several weeks.

即使是導致肺結核的細菌，其生長速度非常緩慢，但抗藥菌仍可在數週內出現並擴散。

Bacteria are also able to share genes, some of these confer the ability for bacteria to infect their host and other confer antibiotic resistance.

細菌能夠分享基因，其中一些傳播傳染宿主的能力，另一些則傳播抗生素抗藥性。

Again, acquiring resistance gives an evolutionary advantage to those bacteria with the resistance genes over the antibiotic susceptible population. Again, these bacteria survive and grow up very quickly. Any use of antibiotics will select antibiotic resistant bacteria and the more that antibiotics are used (and if there is insufficient dosing to kill any bacteria), then the environment is made to drive and select antibiotic resistant bacteria.

再一次，獲得抗藥性使這些具有抗性基因的細菌保有進化優勢。那些對抗生素敏感的細菌被殺死，而這些細菌活了下來，成長的非常快。每一次抗生素的使用是對抗生素抗藥菌的篩選，抗生素使用的越多（且如果劑量不足以殺死任何細菌），那麼抗生素創造的環境將篩選和保留抗生素抗藥菌。

In which areas of the world is the risk highest? Why are certain areas at higher risk?

世界上哪些地區風險最大？爲什麼？

Selecting antibiotic resistant bacteria can occur anywhere at any time an antibiotic is used, whether it be in people, animals or the environment. Therefore, areas with the highest use of antibiotics, and where dosing is not carefully adhered to, or where antibiotics are freely available, without prescription, means that the risk of selecting antibiotic resistant bacteria is greatest.

當使用抗生素時，無論什麼時間、什麼地點、使用對象是人類、動物還是環境都有可能導致產生抗生素抗藥菌。因此，那些頻繁使用抗生素，沒有掌握正確的使用劑量，或抗生素隨處可得，沒有按處方使用的地區最有可能產生抗生素抗藥菌。

Why is this phenomenon so frightening? As this tragedy spreads, without being alarmist, what is the worst case scenario we could be looking at globally?

爲什麼這種現象這麼可怕？如果抗生素抗藥菌四處蔓延，這不是危言聳聽，我們所面臨的最糟糕情況是怎樣的？

The phenomenon is frightening because these bacteria cause infections that are so difficult to treat. With so few drugs active against resistant bacteria, patients will now suffer from untreatable infections.

這種現象的可怕之處在於抗生素抗藥菌造成的感染很難醫治。有效治療抗藥菌的藥物非常稀少，病人將會飽受無法治癒的感染折磨。

This will occur more and more often until we have new ways to prevent and treat bacterial infections.

這種現象將變得愈加頻繁，直至我們找到預防和治療細菌感染的新方法。

The worst case scenario is that many common place treatments no longer work and people start to die from infections that until recently were fully treatable.

最壞的情況是許多常見的治療方式不起作用，某些直至最近才能徹底治療的細菌感染將致人死地。

What are the key issues that need to be addressed to solve this calamity?

解決這個災難的關鍵是？

The key issues are that we must minimise and prevent the opportunities for bacteria to infect people (and animals) and minimise the use of antibiotics so that they are only used when needed to treat a bacterial infection.

解決問題的關鍵在於我們應該儘可能減少和預防細菌感染人類（和動物）的機會；儘量減少使用抗生素，僅在治療細菌感染時使用。

We need new ways to diagnose bacterial infections quickly so the correct treatment is used, and we need new treatments, including new antibiotics that are active against antibiotic resistant bacteria.

我們必須找到快速確診細菌感染的新方法，對症下藥；我們需要新的治療方式，包括新的抗生素，能有效對抗抗生素抗藥菌。

To do all of this, new research is required, not least to find the best doses and strategies to minimise the selection of resistant bacteria.

爲了達到這一目的，我們必須展開新的研究，而不僅僅是找尋最合適的劑量和方案以減少抗生素抗藥菌的產生。

Why is it that these superbugs evade even the hardest-hitting or last resort antibiotics, like carbapenems (antibiotics which are resistant to most bacteria)? Why are these bugs so super strong?

爲什麼這些超級細菌能夠侵入最強力，最頑強的抗生素？比如碳青黴烯（對大部分細菌都有效的抗生素）？爲什麼這些細菌這麼厲害？

These bacteria are not super strong. They have just been exposed to many different antibiotics over decades, allowing them to add antibiotic resistances in the same way as trains add carriages.

這些細菌並不厲害。他們只是在數十年間歷經多種不同的抗生素，使他們能夠像火車加車廂一樣具備抗生素抗藥性。

Where does India connect in all this? How much of a problem is this in India? Are there any diseases in particular that India needs to be worried about?

印度和這些有什麼關係？這些問題在印度常見嗎？哪些疾病是印度需要特別關注的？

Some antibiotic resistances were first detected in India.

一些抗生素抗藥性在印度是首次發現。

One of the reasons for this is that many antibiotics are used in India, and often these have been bought by patients and not used under prescription. This means that antibiotics are used very widely, not always to treat bacterial infections and not always at the correct dose.

原因之一是印度濫用抗生素的現象十分普遍，許多病人未經醫囑隨意購買抗生素。這意味着抗生素既沒有按照正確的計量使用，也並不總用來治療細菌感染。

This therefore provides a 'breeding ground' for the development of antibiotic resistant bacteria.

這爲抗生素抗藥菌提供了發展的‘土壤'。

In what manner does India need to join the fight?

印度該如何對抗抗生素抗藥菌？

India, via the Chennai Declaration (external link,) is already starting to address the issues of over-prescription of antibiotics by hospital doctors. In addition, with increased awareness it is hoped that use of antibiotics in all sectors will be reduced.

金奈宣言（印度醫療界解決抗生素抗藥性問題的宣言）說明印度已經開始解決醫院醫生濫開抗生素的問題，除此之外，隨着認識的提高，使用抗生素治療所有疾病的現象將有所緩和。

What is the most basic advice and precautions you can offer the Indian public, including those who may be illiterate? And what is the most important advice you can offer Indian doctors?

皮多克教授，您能向印度大衆，特別是那些不識字的人給予一些基本的建議和提醒嗎？至於印度醫生，您覺得最重要的意見是？

The best advice is to have as good hygiene as possible and so prevent infection.

最好的建議是儘可能保持衛生，預防感染。

Secondly, if an individual gets an infection, to do their best not to pass on the infection to other members of their household, school or workplace.

第二，如果有人被感染，儘可能不要傳染給家人、學校師生或同事。

To also help this, people should not share washcloths, towels or clothes until they have been washed and any bacteria removed. The same goes for preventing transmission of viral infections.

還有一點可能有所幫助的是，除非經過清洗和消毒，人們不應該共用面巾、毛巾或衣物。這一點對於預防病毒傳播也非常有效。

For Indian doctors, they should only use antibiotics to treat infections that are likely to be caused by bacteria. They should be aware of local antibiotic resistance patterns so that they can make the best choice of effective antibiotics.

至於印度醫生，他們應該對疑似細菌引起的感染使用抗生素。印度醫生應該瞭解當地抗生素的抗藥模式，這樣他們能選擇最有效果的抗生素用於治療。

They need to make sure that they use the correct dose and for the appropriate duration and encourage their patients to take the antibiotics properly.

印度醫生應該確保使用正確的劑量，適當的用藥時限並鼓勵病人按需使用抗生素。

What does the Indian government need to do on a war footing?

在與抗生素抗藥性作鬥爭時，印度政府需要做哪些工作？

The Indian government should sign up to the WHO Global Action Plan and do their best to implement it to meet the needs of India and address the current resistance concerns specific to India.

印度政府應該簽署世界衛生組織全球行動計劃，盡全力實施這項計劃以滿足印度的需要。解決印度特有的抗生素抗藥性問題。

Is it a race to find better antibiotics? Or a matter of looking at other creative options too and what could they be?

我們應該就尋找更好的抗生素展開競賽嗎？還是應該尋找其他更有創造力的解決方案？

What are the key issues hampering the bringing of new antibiotics to the global markets quickly and in more variety?

是什麼在阻礙新抗生素以各種形式快速出現在全球市場上？

There are numerous key issues hampering bringing new antibiotics to market, not least regulatory hurdles and that the business model for antibiotics needs to be different to that for drugs for other therapeutic areas.

阻礙新抗生素上市的原因太多了，不僅僅是監督障礙，還有抗生素的商業模式必須與其他領域的藥物有所區別。

All options, including new antibiotics, should be explored.

我們應探索所有的解決方案，包括髮明新抗生素。

How are superbugs different from regular bugs apart from their ability to resist bacteria?

除了抗藥能力之外，超級細菌與普通細菌還有什麼區別嗎？

Superbugs only differ from 'regular' bugs in that they are antibiotic resistant. Very few antibiotic resistance mechanisms make bacteria fitter.

超級細菌和‘普通'細菌的區別只是抗生素抗藥性。很少有抗生素抗藥機制能把細菌變得更強。

When AIDS came on the scene people quickly got to know about the disease and its causes although prevention took longer. Why has awareness about superbugs, which is as scary, taken longer?

當AIDS出現時，人們很快就瞭解了這種疾病及其病因，雖然理解AIDS預防措施的時間長了些。爲什麼超級細菌這麼可怕，人們卻並不很瞭解它？

People become very frightened of AIDS because it was a terminal disease for which there is no cure.

人們非常害怕AIDS，因爲這是一種不治之症。

For antibiotic-resistant bacteria, we still have some cures although these are diminishing in number day by day.

儘管治療抗生素抗藥菌的方法日漸稀少，但仍是可以治癒的。

AIDS also affected particular demographic groups, who were extremely vocal in bringing this to public awareness. Unfortunately, people are used to getting infections and used to being able to treat them with antibiotics.

AIDS還對特定人羣產生影響，這對喚醒大衆的認知非常有說服力。不幸的是，印度人已經習慣了被感染和依賴抗生素進行治療.